Audiology and Neuro-Otology最新文献

Introduction: Sudden sensorineural hearing loss (SSNHL) is one of the most common acute symptoms in the otolaryngology department. Etiological diagnosis is the premise of effective treatment of SSNHL, and prognostic evaluation is the key. However, most of the patients are diagnosed as idiopathic due to a lack of overall assessment, while prognostic factors of SSNHL are numerous and controversial. Our purpose was to validate the potential value of a novel three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MR protocol in SSNHL and to establish a clinical-image prognostic model for unilateral SSNHL.

Methods: This prospective study included consecutive patients from May 2019 to November 2021. Pathogenic diagnosis relied on expertise-based estimation and the associations of MR findings with clinical features of unilateral SSNHL were assessed. The prognostic evaluation of unilateral SSNHL was adopted for recovery and no recovery groups and complete and incomplete recovery groups. Significant clinical and MR features were compared and screened out by single-factor analyses. The primary clinical-image prognosis assessment model was built by multifactor logistic regression analyses.

Results: A total of 101 patients were enrolled in our study who acquired the correct etiological diagnosis based on the novel 3D-FLAIR MR combined with clinical examination. Among the 93 patients with unilateral SSNHL, 30.1% (28/93) showed labyrinthine abnormalities on 3D-FLAIR images. The severity of initial hearing loss in the MR+ group was worse than that in the MR- group (p < 0.05), and patients with positive MR findings tended to have poor recovery. An excellent prognostic model was built for hearing complete recovery and no recovery. The combination of three independent risk factors, including abnormal distortion products otoacoustic emission and transient evoked otoacoustic emission, the period from onset to treatment, and PTA at the onset, was adopted for hearing recovery/no recovery (accuracy = 90.2%, AUC = 0.820). Furthermore, adding the factor of positive MRI findings could improve the confidence for the judgment of hearing no recovery. The only independent risk factor, PTA at the onset, was adopted for complete/incomplete hearing recovery (accuracy = 86.1%, AUC = 0.874).

Conclusion: The novel MR protocol had a good advantage in pathogenic diagnosis. Labyrinthine MR 3D-FLAIR signal abnormalities were related to the severity of an initial hearing loss and had a greater tendency to be found in patients with no recovery. A prognostic model with two main steps of unilateral SSNHL, mainly for SSNHL with no recovery and complete recovery, was built successfully and needed further verification by larger series of patients.

Introduction: Noise can induce hearing loss and reduce speech understanding. The Acceptable Noise Level (ANL) test has been widely used in audiology. However, strategies used by listeners to determine ANLs are unclear. The current study evaluated the role of speech recognition in selecting ANL and how well ANL could predict speech understanding in a noisy situation.

Methods: Forty-five Mandarin speakers with normal hearing were tested in both ears. ANL is defined as Most Comfortable Level (MCL) minus Background Noise Level (BNL). To obtain ANL monaurally with an earphone, the study measured participants' MCL to hear a Mandarin story in quiet and the maximum BNL to tolerate while following the story. Then, based on the participant's ANL, speech recognition in noise was examined using a set of phonemic-balanced Mandarin words. The signal-to-noise ratio (SNR) was adjusted to ANL, ANL - 10 dB ("degraded noise condition"), and ANL + 10 dB ("improved noise condition").

Results: The mean ANLs were 2.4 dB and 2.6 dB for the left and right ears, respectively. The mean speech recognition with SNR adjusted to ANL was relatively high for both ears (81-83% correct). Even for those ear samples with very low ANL (<0 dB), speech performance obtained at SNR = ANL was still high. The mean speech recognition obtained at SNR = ANL was 5 percentage points lower than the mean speech recognition at the improved noise condition and 14 percentage points higher than the mean speech recognition at the degraded noise condition. Speech recognition obtained at SNR = ANL and ANL - 10 dB correlated significantly with ANL.

Conclusion: Speech recognition in noise appears to play an important role for listeners with normal hearing in deciding their ANLs. Additionally, ANL can predict speech performance (r-squared = 53-61%) in the degraded noise condition.

Introduction: The aim of the study was to describe auditory and vestibular findings in Brazilian adults after COVID-19 in a municipality from the outskirts of the São Paulo state.

Methods: This was a transversal and exploratory study comprising sixteen participants infected by the SARS-CoV-2 virus, confirmed through RT-PCR detection, aged 20 to 55 years. Subjects underwent anamnesis, vestibular and auditory testing. Fisher's exact test was used to evaluate medication use, chemical and physical exposure, and occupational risk and McNemar test was used to compare auditory and vestibular symptoms pre- and post-COVID-19.

Results: Most patients were women (75%) and had been exposed to the virus over 90 days before testing (50%). 18.8% used hydroxychloroquine, 68.8% used ivermectin, and 87.5% used azithromycin to treat COVID-19. Auditory complaints were reported by 31.2% and vestibular by 18.7%. There was no statistical difference before and after the disease. Other reported symptomatology was hair loss, pain, fatigue, memory loss, difficulty to concentrate, and headache. Auditory findings were relevant in contralateral acoustic reflex, in the distortion-product otoacoustic emissions, and in the brainstem auditory evoked potential, characterizing a neurosensorial compromise. 43.74% of patients had altered vectonystagmography. When comparing both ears, no statistical relevance was found; however, when results were crossed with medication use and exposures, there was statistical relevance in the amplitude of the V wave for medications and absolute latency of the V wave to exposure to physical agents.

Discussion/conclusion: This study demonstrated auditory and vestibular findings of neurosensorial nature, considering hearing and of a peripheral vestibulopathy. As it is a study of transversal nature, it is not possible to extend results to general population; yet it may be a finding to future studies.

Introduction: Migraine is the third most common disease in the world with an estimated prevalence of 14.7%. The purpose of this study was to identify the characteristic changes in cervical and ocular vestibular evoked myogenic potential (VEMP) and analyse changes in symptoms and VEMP after flunarizine therapy in patients diagnosed with vestibular migraine (VM).

Methods: Prospective interventional study was conducted on 31 VM patients. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were recorded. Flunarizine (10 mg) was given once daily for two consecutive months. Prophylactic therapy was monitored with a monthly follow-up assessment of their symptoms and VEMP was repeated after 2 months.

Results: Headache was the chief complaint (67.7%). Vertigo was spontaneous and mostly moderate in intensity (93%). cVEMP was absent in 1 patient and oVEMP was absent in 3 patients. Post prophylactic treatment with flunarizine, there was significant reduction in the frequency (p = 0.001) and duration (p = 0.001) of headache and frequency (p = 0.001), duration (p = 0.001), and intensity (p = 0.009) of vertigo. cVEMP and oVEMP showed no significant differences (p > 0.05) between pre- and post-treatment recordings.

Conclusion: Treatment with flunarizine helps in considerably reducing the episodes and duration of headache, as well as episodes, duration, and intensity of vertigo.

Introduction: Diagnosing Ménière's disease (MD) by its characteristics such as episodes of vertigo, fluctuating hearing loss, and tinnitus with aural fullness remains challenging. Available tests evaluating the presence of endolymphatic hydrops (EH) are often expensive or time assuming. An in-office quick and simple non-invasive diagnostic test is multifrequency tympanometry (MFT). It can measure conductance at 2 kHz probe tones, which was demonstrated to reflect variations in cochlear pressure. Previous studies investigating MFT as a diagnostic test for MD showed conflicting outcomes possibly biased by their retrospective design.

Methods: We prospectively collected MFT results (Y width) in patients with dizziness and compared MFT test results in affected (group 1) and unaffected (group 2) ears of 37 MD subjects and in control ears of 33 non-MD subjects (group 3).

Results: The mean value of the Y width in affected ears was 315.6 ± 70.2 daPa compared to 292.3 ± 98.6 daPa in unaffected ears in MD subjects and 259.4. ± 60.6 daPa in the non-MD group. A positive test result (i.e., a Y width of 235 daPa or more) was found in 35 ears in the MD group, 21 times involving the affected ear and 14 times involving the unaffected ear, compared to 16 in the non-MD group. No significant differences between the three groups could be demonstrated (p > 0.05). We found a sensitivity of 58.3% and specificity of 66.3% for detecting EH in an affected ear in MD subjects.

Conclusion: There is a trend towards increased conductance tympanometry in affected ears. However, we noticed a high false positive rate of MFT and do not support standardized use of MFT as an additional diagnostic tool for detecting EH in MD patients. A negative test result on the contrary is unlikely related to EH.

Introduction: During the coronavirus disease 2019, pandemic clinical practice had to change, and this study trialled a diagnostic questionnaire to assess patients with dizziness over the telephone.

Methods: All 115 patients awaiting otorhinolaryngological assessment for balance were randomised to receive a dizziness questionnaire in the post prior to their telephone consultation or not. Consultation outcomes were recorded by the clinicians conducting the consultation. Follow-up data were collected in June 2022 for final outcomes.

Results: 82/115 patients had consultations with complete data collection: 35 in the questionnaire group (QG) and 47 in the no questionnaire group (NQG), with a 70% response rate in the QG. Clinicians made a diagnosis in 27/35 QG consultations versus 27/47 NQG consultations. Nine out of 35 QG patients required additional investigations compared to 34/47 in the NQG (p < 0.05). Only 6/35 QG patients needed additional telephone follow-up, compared to 20/47 NQG patients (p < 0.05).

Conclusion: Using a diagnostic questionnaire increased clinicians' ability to come to a diagnosis in telephone consultations.

Introduction: The study aimed to investigate binaural cues in the rehabilitation of unilateral occluded ears with a bone conduction hearing aid.

Methods: The study sample consisted of 40 adult volunteers with normal hearing. Unilateral pseudo-conductive hearing loss was induced by inserting an earplug into the external auditory canal (EAC) and silicone material in the concha for ear impression. The adaptive speech-in-noise test (Italian Matrix test) was performed in three spatial orientations to assess binaural cues (summation, squelch, and head shadow effects). All evaluations were performed in the normal condition, after EAC occlusion, and after application of an adhesive bone conduction hearing aid. Binaural contrast differences were calculated in the three conditions.

Results: In the EAC occlusion condition, there was a significant increase in the signal-to-noise ratio (SNR) in both the S0N0 (2.4 dB) and the S90N-90 (7.7 dB) settings, and a slight albeit significant increase in the S0N90 setting (1.35 dB). After fitting the BC hearing aid, there was a reduction of -1.8 dB SNR (p < 0.001) in the S0N0 setting and -2 dB (p = 0.003) in the S90N-90 setting. There was no improvement in the SNR (p = 0.405) in evaluation of the squelch effect (S0N90). These data were corroborated by a better binaural contrast due to a reduction in the summation effect in the monaural occlusion condition and a subsequent reduction in binaural contrast after fitting the hearing aid due to an increase in the summation effect (-2.5 dB vs. 0.3 dB; p < 0.001).

Conclusions: Application of a bone conduction hearing aid in unilateral pseudo-conductive hearing loss strengthens speech recognition of noise by improving the summation effect and impeding the shadow effect of the head; however, there appears to be no improvement in speech perception in noise due to spatial release from masking.

Introduction: The amount of listening effort needed to understand speech in every-day life is an important outcome measure of the effectiveness of a hearing device. The main goal of this study was to assess subjective listening effort in patients implanted with an active middle ear implant Vibrant Soundbridge (VSB) with and without using their speech processor in complex acoustic scenarios.

Methods: Ten VSB users were measured using the adaptive categorical listening effort scaling (ACALES) method in four different acoustic scenarios, realized using a multichannel loudspeaker array. The four acoustic scenarios included both spatially simple and complex speech and noise arrangements that realistically simulated challenging every-day listening situations. Signal-to-noise ratios (SNRs) were adaptively varied during the measurement. Twelve normal-hearing (NH) listeners performed the same experiment as a control group.

Results: Listening effort was significantly reduced in all tested acoustic scenarios when participants used their VSB. When using the VSB, SNRs corresponding to mild-to-moderate listening effort were found not to be statistically different from SNRs found in the NH control group. SNRs corresponding to extreme listening effort of VSB users approached NH values, indicating partial restoration of listening effort.

Discussion and conclusions: Usage of the middle ear implant VSB was found to restore subjective listening effort to normal at high SNRs completely, and at lower SNRs partially. The remaining gap at low SNRs may be due to lower effectiveness of signal processing at high noise levels or due to the microphone location effect.

Introduction: In order to understand human hearing, it helps to understand how the ears of lower vertebrates, like, for instance, lizards, function. A key feature in common is that the ears of both humans and lizards emit faint, pure tones known as spontaneous otoacoustic emissions (SOAEs). More than four decades after their discovery, the mechanism underlying these emissions is still imperfectly understood, although it is known that they are important for improving the sensitivity and sharpness of hearing. In both humans and lizards, the frequencies of SOAEs change by a few percent when static pressure is applied to the tympanic membrane. For the human ear, this observation is normally explained by a so-called global oscillator model (such as with Shera's coherent reflection model), in which the emissions result from standing waves, and external pressure changes the boundary conditions - the stiffness of the oval and round windows - which then has a global effect on the SOAE frequencies.

Methods: Here we investigate how changing parameters of an earlier developed local oscillator model for the lizard ear can change the frequencies of the SOAEs. A major feature of the model is that each oscillator is coupled only to its immediate neighbours. The oscillators then cluster into groups of identical frequency, and each of these so-called frequency plateaus can be taken to represent an SOAE.

Results: Even though the natural (unperturbed) frequencies of all the oscillators remain fixed, here we find for several model parameters that by slightly changing their value the frequency plateaus - the SOAEs - shift by a few percent. Plots of how these changes alter SOAE frequencies are given, and their magnitude corresponds well with observations of SOAE changes in lizards.

Discussion: Investigation of the influence of the change of parameters in an earlier developed local oscillator model for the lizard ear shows that a local oscillator model can explain small SOAE frequency changes as well as a global oscillator model.